| NPI | 1902590763 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN 2783) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN 2783) |
| Enumeration Date | 2023-06-05 |
| Last Update Date | 2024-12-26 |